Enhancing Quit & Win contests to improve cessation among college smokers: A randomized clinical trial

Background and Aims: Quit & Win contests (in which smokers pledge to quit smoking for a defined period in exchange for the chance to win a prize) may be well-suited for college smokers. We tested the effectiveness of multiple versus single Quit & Win contests and that of added counseling versus no counseling in smoking cessation. Design: A two-by-two, randomized controlled trial with 6-month follow-up. Setting: Nineteen institutions in Minnesota, Texas, Ohio and Wisconsin. Participants: College student smokers (n=1217) were randomized within site to four conditions: single (n=306), multiple contests alone (n=309), single contest plus counseling (n=296) or multiple contests with counseling (n=306). Intervention: Participants in the standard contest condition (T1 and T2) were asked to abstain from all tobacco products for a 30-day period; those with confirmed abstinence were eligible for a lottery-based prize. Participants assigned to the multiple contest conditions (T3 and T4) participated in the 30-day contest and were enrolled automatically into two additional contest periods with an escalating prize structure. Participants randomized into the counseling conditions (T2 and T4) received up to six telephone-administered Motivation and Problem Solving (MAPS) counseling sessions over the 12-week treatment period. Measures: The primary outcome was biochemically verified 30-day point prevalence (PP) abstinence rate at 6 months. Secondary outcomes were the same abstinence at end of treatment (4 months) and a proxy measure of 6-month verified continuous abstinence rate. Outcomes were based on all participants randomized. Findings: We found no evidence of an interaction between number of contests and counseling. Abstinence rates for multiple (13.5%) and single (11.7%) contests were not significantly different at 6months [odds ratio (OR)=1.18, 95% confidence interval (CI)=0.84-1.66]. The addition of counseling did not improve 6-month abstinence significantly (13.7 versus 11.6%, OR=1.21, 95% CI=0.86-1.70). Multiple contests increased abstinence at 4months (19.3 versus 10.3%, OR=2.09, 95% CI=1.50-2.91) and continuous abstinence at 6months (7.8 versus 3.8%, OR=2.14, 95% CI=1.28-3.56). Conclusion: Multiple Quit & Win contests may increase smoking abstinence rates in college students more than single contests, but it is not clear whether adding counseling to these interventions produces any additional benefit.